High-dose dexamethasone compared with prednisone for previously untreated primary immune thrombocytopenia: a systematic review and meta-analysis

Immune Thrombocytopenia - Current Diagnostics and Therapy: Recommendations of a Joint Working Group of DGHO, ÖGHO, SGH, GPOH, and DGTI

“…Specific effects on Tregs and myeloid suppressor cells have been noted. Several comparative studies describe higher long-term remission rates when dexamethasone instead of prednisone is given in the first line [69][70][71], while others do not find an advantage [72,73]. Cushingoid changes are not as frequent with dexamethasone as with prednisone [70].…”

Management of newly diagnosed immune thrombocytopenia: can we change outcomes?

“…6,9 Since that time, a number of randomized trials have addressed this topic, and cumulative results of these trials were published in a systematic review (Table 3). 11 The primary aim of the systematic review was comparison of 6-month response rates, either overall (.30 3 10 9 /L) or complete (.100 3 10 9 /L), between patients receiving short courses of dexamethasone and longer courses of prednisone. Four trials met criteria for assessment of the primary outcome (n 5 459 patients).…”

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“…These data were not included in the previous meta-analysis 11 and are newly revealed in the subgroup analyses of the present study. We used the fixed-effect model to synthesize SR data because of the low heterogeneity in each subgroup (I 2 ¼ 0% in Dex with posttherapy; I 2 ¼ 22% in Dex monotherapy); the same conclusions were obtained if we used the random-effects model.…”

“…11 This analysis, however, had several limitations, such as the inclusion criteria (only literature written in English was included) and lack of subgroup analysis of the corticosteroid dosage (due to the small number of included studies). Among the excluded studies, there were at least two large-sized RCTs published in Chinese (total N ¼ 153).…”